“The relationship between depression and infertility is complex. Many women in our study screened positive for depression,” lead author Dr. Natalie Crawford told Reuters Health in an email.

Dr. Crawford, who is currently medical director of fertility preservation at Austin Fertility Institute in Texas, led the study while she was at the University of North Carolina (UNC) in Chapel Hill.

While she was at UNC, all patients were given questionnaires to screen for depression and providers noticed that many women tested positive.

“We suspected that women who did screen positive for depression were less likely to comply with infertility treatment recommendations,” Dr. Crawford said.

“Our study revealed that women who have a screening test correlating with depression were less likely to proceed with infertility treatments, likely making it harder to achieve the ultimate goal of pregnancy,” Dr. Crawford said.

The research team sent electronic questionnaires to 959 women. The surveys were designed to screen for mental health disorders and patients’ perception of mental health disorders and fertility.

Of the 416 women who answered the questionnaire, more than half had been trying to conceive for more than two years.

Although 41 percent actually tested positive for depression based on their questionnaire responses, 50 percent of the women with infertility said they felt depressed most or all of the time.

Only 36 percent of the women who screened positive for depression went ahead with fertility treatments compared to 64 percent of women who did not have depression, according to the results published January 9 in the journal Human Reproduction.

Dr. Crawford said that if people have friends or family members who are struggling with infertility, it is important to acknowledge their difficulty.

“I think simply starting the conversation is the hardest part. Couples who have infertility often report social isolation,” she said. “Thus, supporting friends and family who are suffering can be extremely helpful. Express your feelings clearly.”

Patients might not realize that their avoiding fertility treatment may be, in fact, a sign of the stress infertility is causing them, said Dr. Heather Shapiro, who wasn’t involved in the study.

Dr. Shapiro, vice chair of education in the Obstetrics and Gynecology department at the University of Toronto, said she thinks that fertility doctors are generally familiar with the problem of patients avoiding or delaying treatment due to depression or anxiety or some kind of emotional response to fertility.

It might help if family and friends recognize that when someone has started and then abandoned fertility treatment, there’s a good chance that there’s a major stress component to that, she said.

“If you’re in a position to address that stress component either as an informal family support member or professional support member, addressing the stress directly would probably in the long-term help their fertility,” Dr. Shapiro said.